On Freud's "The Question of Lay Analysis"

Contemporary Freudian Turning Points and Critical Issues

Paulo Cesar Sandler, Gley Pacheco Costa, Paulo Cesar Sandler, Gley Pacheco Costa

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429664922
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

The questions of what psychoanalysis is, and does, and who can and should practice it, remains key within the modern profession. Has the invaluable material packed into Freud's The Question of Lay Analysis (1926) been underestimated by contemporary psychoanalysis? This book explores how the issues raised in this paper can continue to impact contemporary Freudian theory and practice. The chapters examine why the arguably litigious nature of the paper might be contributing to its neglect and underestimation.

The editors of this book put forth a hypothesis: is there an underlying, still unrecognized, but heartrending factor underlying the century-old quarrel between "lay analysts" and what might be described as medically or psychiatrically trained analysts? They then brought together a selection of major contemporary psychoanalytic thinkers from around the world to attempt to bridge the seemingly unbridgeable gap between medical and non-medical analysis, using The Question of Lay Analysis as a central pivot. The work of the key figure, in social and historic terms, on this issue, Theodor Reik, is also duly honoured.

On Freud's "The Question of Lay Analysis" will be of great interest to all psychoanalysts and psychoanalytic psychotherapists.

1

The question of lay analysis

Then and now

Ron Spielman

My Dear Sigmund,

I have been asked to write something about your 1926 paper “The Question of Lay Analysis”.

I am now retired after just over 30 years practicing as a “medical” psychoanalyst, having been a psychiatrist for some 12 years before qualifying to join your International Psychoanalytic Association in 1984. I trained with the Australian Psychoanalytic Society, which I will make relevant later.

I will not be the first to acknowledge that every time I pick up something you have written, I (like so many others!) find not only something “new”, but something “awesome” in that you had some concept of issues with which we now – in 2019! – are so familiar. But you were a pioneer in so many details of issues involved in psychoanalytic practice.

My awe in this instance begins with the subheading to your title: “Conversations with an Impartial Person”.

I know you have often written your papers with a sceptical reader – almost an adversary – in mind. But I read “impartial person” in this instance with a sense of your irony (do you intend this?) as I imagine you have more than made the case that such an impartial person, according to your own key concepts, cannot exist. No one can know their unconscious biases well enough to be “truly” impartial about anything! Yet, you invoke the idea of impartiality as a prelude to addressing what you clearly see as a vexed and complex issue.

You say in your very first paragraph (p. 183), “This question has its limitations in both time and place” and, indeed, it does. Perhaps more than even you knew when writing this paper in your time and at your place.

You address immediately the question of the place of psychoanalysis in the broader culture as opposed to its restriction to (or even rejection from!) medical practice.

You cannot have anticipated the irony (in present times) of your sentence:

it (the question) does not arise in all countries with equal significance. In Germany and America it would be no more than an academic discussion; for in those countries every patient can have himself treated how and by whom he (nowadays, we have to add “or she”) chooses, and anyone who chooses can as a “quack”, handle patients provided only that he (or “she”! So many of your present day colleagues are now women!!) undertakes the responsibility of his actions.

We can forgive you the use of the term “quack” because we know (in house) what you mean by it (and you say so toward the end of your paper), but please don’t use it too often in public as it is not “politically correct” these days to do so.

The irony suggested above is that “in America” – and perhaps “only in America” – there was a protracted period where “lay analysts” (as you write, “non-doctors”) were excluded from becoming members of the American Psychoanalytic Association – which institution was the “Component Society” (I don’t know if you are familiar with this term) in the United States of America which had “the franchise” accorded by the IPA to have responsibility for training future psychoanalysts. The APA has had many “institutes” under its umbrella – but held exclusively the right to train only medical persons (most often psychiatrists) in psychoanalysis.

I am happy to let you know that under the courageous leadership of one of your most admirable followers, Dr. Robert Wallerstein (himself an American) while president of the IPA from 1985 to 1989, carefully negotiated a major court case in the USA, brought against the IPA by psychologists in America, the fortunate outcome of which was to include “non-medical” mental health professionals in the trainings offered by APA institutes. In 1998, Wallerstein actually wrote a long book about his experience called Lay Analysis – Life Inside the Experience.

Now … Germany! The country which once burned your books is among the very few countries whose national health systems currently support psychoanalytic treatments with substantial public funding. (Australia is another!) Now that’s an irony! If only the relevant reasons hadn’t made it so.

Now, you define the “territory” of your important question (of “lay analysis”), as ever, so admirably and logically at the end of your introduction:

Neurotics are patients, laymen are non-doctors (regrettable term!), psychoanalysis is a procedure for curing or improving nervous disorders, and all such treatments are reserved to doctors. It follows (ergo!) that laymen are not permitted to practice analysis on neurotics, and are punishable if they nevertheless do so. (I take the liberty of including in the brackets my need to add to your point.)

Not so simple in 2019!

This may well have been the “rationale” for the American Psychoanalytic Association excluding “laymen” – albeit the ones challenging their exclusion from IPA training were highly qualified professionals (psychologists and social workers).

But, as you will not necessarily know, because you published your paper in 1926, just 10 years before you tragically, for your stage of life, and urgently (because of the Nazi domination of Europe) had to hurriedly leave Vienna and migrate to London in 1936, for your own safety, that London was to become one of the most important and creative centres of psychoanalytic thought and practice – not least due to a considerable number of so-called lay analysts.

Leading among these “lay analysts” in London was your very own daughter Anna! She became such an influential contributor to our field, among so many others, for many decades after your death in 1939.

This is only to say, that again, ironically, what you were so concerned about leading up to publishing your paper on “the question of lay analysis” from Vienna in 1926 hardly was an issue at all in Britain where psychoanalysis took root in London and has flourished admirably ever since.

This is not to say that the issues you addressed in the body of your paper are now what we might nowadays term a “non-issue”. They remain of significance – but only in the context, as you so presciently alluded, “to do with time and place”.

I have already made the point (I hope) that “the question” is not a universal one: in at least one country (America) it was a major issue (but no more) and in most others in Europe and Latin America and – you will be surprised to learn – in India, in Israel and now in many Asian countries (Japan, Korea and China, particularly) it is not an issue at all!

Nevertheless, your “conversation with an impartial person” still retains relevance as to the “standing of psychoanalysis” in the firmament of human knowledge, alongside its acceptance, or rejection, as a method of treatment of mental disorders.

You, yourself – now famously – defined psychoanalysis in a “tri-partite” manner: as a theory of mental functioning, as a body of concepts and as a method of investigating (a “tool” you called it) and treating disorders of the mind.

I can safely let you know that psychoanalysis has claimed an important place in the realm of human knowledge and thought. So much of what you pioneered is taken for granted in intelligent company and so much has become part of our understanding of human behaviour on the broadest cultural level – let alone in understanding mental disorders of all kinds. A famous British poet, W.H. Auden, in a eulogy following your death wrote that you “are no longer a person, but a whole climate of opinion”. What a tribute to you! You have permeated Western culture with your ideas.

The concepts derived from your work and added to by so many important contributors since you lived and worked in Vienna are our business as clinicians, and we all depend on them in our day-to-day work.

But, the realm of psychoanalysis’ efficacy and relevance to treatment of mental disorder continues to be such a fraught issue – even though we continue to derive benefit for our fellow humans by deriving insights into issues of mental function through psychoanalytic investigation of the minds of those who seek us out.

Indeed, the important issue of what are the indications for psychoanalysis and its efficacy in treating what will come to be referred to as the “widening scope” (I’ll tell you more about this later), has occupied considerable research efforts by many colleagues – most notably, I would consider, Peter Fonagy and his colleagues working at University College London.

In 2005, the IPA published Fonagy’s “An Open Door Review of Outcome Studies in Psychoanalysis”. This comprehensive review study grew out of Fonagy’s and some colleagues’, earlier (2002) review “What Works for Whom? A Critical Review of Psychotherapy Research”.

These studies rescued our field from being criticised for “single case” anecdotal reports (of which your early case studies are such exemplars) and located us among those prepared to undertake rigorously controlled outcome studies.

In writing just now “the minds of those who seek us out”, I was aware of how easy it would have been for me to write “our patients” – or in more modern and comprehensive terms, “our clients”. But this is in fact the point of your paper: that people should be free to seek out suitably qualified psychoanalytically trained practitioners – subject to the laws of the land – which you argued may need changing.

In your Section I, you argue that your impartial person can never be in a position to experience what it is to partake in a psychoanalytic process. Were he or she to “undergo” psychoanalysis themselves, they would cease to be “impartial” – they would either become “an advocate for” psychoanalysis or “an antagonist to” psychoanalysis as a result of either successfully resolving relevant issues (in the case of the “advocate”) – or having been resistant to the process and retaining unresolved hostility to the “authority figures” (in the case of the “antagonist/critic” – but I would say that, wouldn’t I?).

Now, in your Section II, you engage in active dialogue with your “impartial person” – almost as if he were in a psychoanalytic relationship with you!

And here the resistances of your hypothetical impartial person become manifest: you are forced, once more, as you have done so often, into defending and advocating for psychoanalysis. You and I (and myriad colleagues) know what you are asserting is true – but not so accessible to anyone who has not had an authentic experience of the psychoanalytic process.

At the end of this Section II (p. 199) you write “How then could I expect to convince you, the Impartial Person, of the correctness of our theories, when I can only put before you an abbreviated and therefore unintelligible account of them, without confirming them from your own experiences?”

We, your modern colleagues, sense – and share – your despair!

But, I have to remind you of your own warning (in your papers on technique) against what you, yourself, called “therapeutic zeal”. Your “zeal” in advocating for psychoanalysis is much appreciated by us all … but you and we, in our more sober moments, understand its futility – and, indeed, in analysis, its undesirability.

As Wilfred Bion, of whom you may have heard something at your “Wednesday Group in Heaven”, was renowned for disavowing any investment at all in what we nowadays think of as “positive outcomes” of analysis – let alone therapeutic zeal itself – in his encounters with his patients.

In Section III, you endeavour to offer your imaginary person a “crash course” in psychoanalytic theory (let us from now on call him “IP” – because it occurs to me that nowadays in modern psychiatric and psychological treatment clinics the “IP” is a term for the “identified patient” in a family dynamic. Your “IP” shares many qualities of many modern “IPs”: carrying and expressing the unrecognised – yet denied – pain of others!).

In your Section IV, you delve into the very realms which are so disconcerting to our many critics: sex!

It is this “sex” which “allows” people to challenge “what has sex got to do with disorders requiring medical treatment – if that is what you Psychoanalysts claim – and then claim that such treatments can be undertaken by non-medical persons. Are you all mad?”

Your IP even challenges you to explore ethics, conscience and ideals. What do these have to do with treatable disorders? You do rise admirably to this challenge.

Amazingly – but perhaps not so – in Section V, your IP expresses interest in becoming an analyst. How often this happens in “real life”! Our analysands (now there’s a better term) so often wish to become psychoanalysts, don’t they? Some of yours did!

The problem – as we modern analysts now understand it (on the basis of decades more actual experience than you could possibly have had) and certainly on the basis of the aggregated experience of generations of psychoanalysts in the more than 100 years since you began this all, that the desire to become an analyst is a complex phenomenon – particularly among those who seek psychoanalytic training.

Our own “candidates” are mostly “suspect” as to their unconscious motivations for even wanting to train (why on earth would anyone want to join our “impossible profession”? – yet another echo of an IP?). These conscious and unconscious “motivations” are legitimately the subject of exploration during any so-called training analysis. But what if they arise in the course of an “ordinary” psychoanalysis? Aren’t they then even more “suspect” and likely to constitute a resistance to some or other unconscious set of issues?

Well, we nowadays would think so. But many of your analysands became psychoanalysts quite readily – and, oftentimes, quite productively. Did your acceptance of this “phenomenon” reflect your own desire for the propagation of psychoanalysis to the extent you may not have adequately analysed the relevant resistances which may have been involved in your – at your time – relatively short analyses? (Just asking.)

Nevertheless, having offered your IP a crash course in theory in the previous section, you now offer a crash course in technique!

Modern candidates will feel envy that you make it so succinct and relatively easy. But – again – you, and we all, know it isn’t possible to acquire the relevant knowledge and skills without the arduous and lengthy participation in a formal psychoanalytic training, involving personal analysis together with supervision and seminars. We now call this the Eitingon Model, after your colleague and friend whom you mention on p. 228. But, under the pressures of time and money in modern times (in the early 2000s), this Eitingon Model is being modified in some societies which make up your IPA. We will have to await the...